For UK Customers Only

Please insert your details below and one of our commercial advisers will contact you shortly with a liability insurance quotation.

This form is designed for quotes for Public/Employers Liability Insurance only. If you require cover for any other type of commercial insurance, please return to our business insurance page. Please note that we are unable to quote for customers based in Ireland.

If you have any problems with completing this form, please phone us on 08453 455 855 for assistance.

Personal/Company Details
Proposers Name(s) (incl. partners names if partnership):
Trading Name:
Trading Status:	- - - - - - Please Select - - - - - Sole Proprietor Partnership Limited Company Limited Liability Partnership Unincorporated Association
Occupation/Trade:
Postal Address:
Postcode:
Daytime Telephone Number:
E-Mail Address:
General Information
Have you, or any other partner or director ever been convicted of any offences, been declared bankrupt/ insolvent or had any insurance refused or cancelled?	Yes     No
Description of your business activities: (Please describe as fully as possible)
Is your home the base for your business or are you operating from separate dedicated business premises?	- - Please Select - - Home Business Premises
Is any work undertaken outside of the U.K.?	Please Select Yes No
Do your activities involve the use of heat?	Please Select Yes No
If yes, please state the type of heat used (e.g. blowlamp) and how frequently it is used:	Type Used: Frequency:
Please state the maximum height you would work or depth you would dig (if applicable):	Max. Height: Max. Depth:
How many years has your business been trading?	Please Select 0 Years 1 Year 2 Years 3 Years 4 Years 5 Years 6 Years 7 Years 8 Years 9 Years 10 Years 11 Years 12 Years 13 Years 14 Years 15 Years 16 Years 17 Years 18 Years 19 Years 20 Years 20+ Years
Number of years experience (if different)	Please Select 0 Years 1 Year 2 Years 3 Years 4 Years 5 Years 6 Years 7 Years 8 Years 9 Years 10 Years 11 Years 12 Years 13 Years 14 Years 15 Years 16 Years 17 Years 18 Years 19 Years 20 Years 20+ Years
Claims Experience
Have you or any other partner or director suffered any loss or had any claims made against you in the last 5 years?	Please Select Yes No
If yes, please provide details:	Date of claim: Cost of claim:£ Details of claim: ---------------------------- Date of claim: Cost of claim:£ Details of claim: ---------------------------- Regrettably, if you have more than 2 claims, we will be unable to provide you with a quotation.

Details Of Cover Required
Public/Product Liability
Public/Product Liability limit of indemnity:	£	1 Million 2 Million 5 Million Not Required
		Manual Principals		Non-Manual/Clerical Principals
Number of Proprietors/Partners/Co. Directors:	No.		No.
Annual Wages of Proprietors/Partners/Co. Directors:	£		£
Employers' Liability (Compulsory by Law if you employ staff)
Is Employers' Liability Cover Required?		Please Select Yes No
		Manual Employees		Non-Manual/Clerical Employees
Number of Employees: (Do not include proprietors, partners or directors)	No.		No.
Total Annual Wages of Employees:	£		£
Please state your annual payments to bona-fide sub-contractors (if used): (BFSC's are sub-contractors who supply their own materials on site and hold their own insurance)	£
Turnover
Annual Turnover:	£
Tools Cover (Optional)
Tools Sum Insured:	£	(£2,500 max sum insured)
Additional Information
Any additional information / cover required:
Van Renewal Date (optional):		(dd/mm/yyyy)

Details Of Current / Previous Policies
Current Annual Premium:	£	This may help us to get you a better quote
Current/Previous Insurer:
Liability Renewal Date (if applicable):		(dd/mm/yyyy)

Request Quotation

Disclosure
Please ensure that all the information you have provided is correct, then press the Request Liability Quotation button and we will contact you shortly with a quotation.